No Surprises Act & Good Faith Estimate
Effective Date: January 1, 2026 | Last Updated: April 19, 2026
What Is the No Surprises Act?
The No Surprises Act is a federal law that went into effect on January 1, 2022. It was designed to protect patients from unexpected medical bills ("surprise bills") and to increase transparency in healthcare pricing. A key provision of this law requires healthcare providers to give patients who are uninsured or who choose not to use their insurance a Good Faith Estimate of expected charges before providing services.
What Is a Good Faith Estimate?
A Good Faith Estimate (GFE) is a written document that provides an estimate of the total expected cost of non-emergency healthcare services. Under the law:
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare items or services
- This includes related costs such as medical tests, prescription drugs, equipment, and hospital fees, if applicable
- The estimate is provided before your scheduled service or upon request
Who Receives a Good Faith Estimate?
You are entitled to a Good Faith Estimate if:
- You do not have health insurance
- You are not using your health insurance to pay for the service (self-pay/private pay)
- You request a Good Faith Estimate before scheduling a service
When Will You Receive Your Estimate?
- Scheduled services: If you schedule a service at least 3 business days in advance, you will receive your Good Faith Estimate within 1 business day after scheduling
- Scheduled services: If you schedule a service at least 10 business days in advance, you will receive your Good Faith Estimate within 3 business days after scheduling
- Upon request: If you request a Good Faith Estimate without scheduling a service, we will provide it within 3 business days
How Pasadena Clinical Group Provides Good Faith Estimates
At Pasadena Clinical Group, we are committed to transparent pricing for our mental health services. When you are a self-pay client, we will:
- Provide a clear written estimate of the expected charges for your treatment
- Include the type and frequency of expected sessions
- Include the expected duration of treatment, based on clinical assessment
- Provide per-session rates for individual therapy, group therapy, and other services
- Update the estimate if your treatment plan changes significantly
Your Rights Under the No Surprises Act
- Right to a Good Faith Estimate: You can ask any healthcare provider for a Good Faith Estimate before you schedule a service
- Right to an Itemized Bill: If your final bill is substantially different from your Good Faith Estimate, you can ask for an itemized bill
- Right to Dispute: If you receive a bill that is at least $400 more than your Good Faith Estimate, you may dispute the bill through a patient-provider dispute resolution process
- Right to Not Be Balance Billed: In certain circumstances involving emergency services or out-of-network providers at in-network facilities, you are protected from balance billing
Dispute Resolution Process
If you believe you have been overcharged (billed $400 or more above your Good Faith Estimate), you may initiate the patient-provider dispute resolution process:
- Contact us first: We encourage you to contact our office at 626-354-6440 to discuss the bill. Many billing questions can be resolved directly
- Initiate a dispute: If the issue is not resolved, you may start a dispute resolution process with the U.S. Department of Health and Human Services (HHS) within 120 calendar days of receiving the bill
- HHS Dispute Resolution: You can initiate the dispute resolution process at www.cms.gov/nosurprises or by calling 1-800-985-3059
Important Disclaimers
- A Good Faith Estimate is an estimate only — it is not a contract or guarantee of final charges
- Actual charges may vary based on the services actually received, changes in your treatment plan, or unforeseen clinical needs
- If your treatment needs change, we will provide an updated estimate
- The Good Faith Estimate does not include unexpected costs that may arise from unforeseen events during treatment
For Insured Patients
If you have health insurance and plan to use it for our services, your costs will be determined by your insurance plan's benefits, including your deductible, copay, and coinsurance. We recommend contacting your insurance company to verify your mental health benefits before your first appointment. You may still request a Good Faith Estimate for informational purposes.
Contact Us
To request a Good Faith Estimate or for questions about the No Surprises Act, please contact us:
Pasadena Clinical Group
301 N. Lake Ave, STE 600
Pasadena, CA 91101
Phone: 626-354-6440
Fax: 323-801-8264
Fax: 323-801-8264
Email: office@pasadenaclinicalgroup.com
Additional Resources
- CMS No Surprises Act Information: www.cms.gov/nosurprises
- No Surprises Help Desk: 1-800-985-3059